Ali Fakhari
1 
, Jafar Sadegh Tabrizi
2 , AbbasAli Dorosti
3 , Vahab Asl-Rahimi
4, Mostafa Farahbakhsh
5 , Habibeh Barzegar
1 , Laleh Gaem Magami
1, Hosein Azizi
1* 1 Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
2 Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of Mental Health, Office of Health Vice-chancellor, Tabriz University of Medical Sciences, Tabriz, Iran
5 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Background. Primary health care system provides appropriate prevention and primary mental care services only for rural population. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements, and challenges of CMHC in Tabriz, Iran.
Methods. This was a qualitative pilot study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city were evaluated from 2015 to 2019 using three methods, including conducting in-depth interviews with two executive managers, holding Focus Group Discussion (FGD) with managers and mental healthcare providers, and collecting mental health care indicators from the patients’ health records. After evaluating the challenges, appropriate recommendations to improve mental health services in urban areas were presented.
Results. A total of 17 specialists and general medical doctors collaborated in this study. During the study, 1053 initial visits and/or screenings and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, were identified during in-depth interviews and FGDs.
Conclusion. It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context
Extended Abstract
Background
Mental health disorders are the first cause of the Disability-Adjusted Life Year (DALY). In Iran, Primary Health Care (PHC) system has provided appropriate prevention and primary mental healthcare services to the rural population. However, this need is not met yet in urban areas, especially in metropolitan cities. The Community Mental Health Centers (CMHC) was developed to provide and promote mental health services in urban areas. The CMHC was established in the United States in 1963 and performed successfully. The similar results regarding the outcomes of CMHC have been reported from Italy, Australia, and Denmark. In 2010, the Iranian model of CMHC was also established in Tehran, Tabriz, Sanandaj, Zanjan, and Kerman. Accordingly, the objective of this study was to outline the performance, achievements, and challenges of CMHC in Tabriz.
Methods
This was a pilot study with mix-method approach. The CMHC outcomes, implications, and challenges were evaluated using three methods from 2015 to 2019.
1) In depth-interviews (two executive managers)
The interviews lasted for at least one hour. The questions were prepared in advance and the interview session was pre-arranged with the interviewees. The interview took place in a private room with the presence of the interviewee and the interviewer. A tape recorder was used to record and save the interviews.
2) Focus group discussion (managers and mental healthcare providers)
A Focus Group Discussion (FGD) was held with the presence of seven participants (two executives, two psychiatrists, one psychologist, one expert, and one general practitioner) to elicit their comprehensive opinions through discussing pros and cons and comparing them with the results of in-depth interviews. The meeting was held at the Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences. The FGD lasted for three hours and the same questions in the in-depth interview section were utilized. Content analysis was performed for data analysis.
3) Mental health care indicators
To evaluate the outcomes and practices of CMHC, we used the indicators related to mental health services provided for outpatients with mental disorders. Health indicators and practices were extracted by reviewing CMHC records and monitoring patient records. The indicators and/or practices included the number of physicians working in the center, the number of visits done by psychiatrists and psychologists, the number of clients, the number and percentage of screening for psychological disorders, the number/percentage of the identified patients, the percentage of referrals to the center by the first level of PHC system, number/percentage of training sessions, percentage of home cares, and follow-up of the identified patients.
Results
A total of 17 specialists and general medical doctors collaborated in conducting the study. During the study, 1053 initial visits or screenings and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, along with subthemes were identified during in-depth interviews and FGDs. The study results and in-depth interviews indicated that the CMHC center not only provided specialized psychiatric and psychological services, but also provided the availability of recognition, screening, caring, treatment, and home care of mental health disorders for the general people at the first line. It could also improve connections between the first and second referral systems. The CMHC center could provide an appropriate context to enhance psychiatric and psychological students’ skills and mental health education.
Conclusion
It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context.